Understanding DBT: acceptance, change and skills
Learn how understanding your responses and practising new skills can work together, with support, realistic choices and protection from harm.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding DBT: acceptance, change and skills
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Understanding and changing together
Dialectical behaviour therapy (DBT), developed by Marsha Linehan, brings together understanding your experience and learning ways to respond differently. Acceptance means recognising what is happening now; change means working towards a more workable life. You can accept where you are now and still want things to change. Holding two truths like these together is what "dialectical" means. Acceptance is not approval of harm or a duty to tolerate abuse. This resource supports trained practice and does not replace it.
Why emotions can become hard to manage
The biosocial model is one way to understand how biology and surroundings affect each other. Some people react strongly or quickly and take longer to settle. Repeated experiences of having feelings dismissed, misunderstood or punished can make learning to manage them harder. Strong reactions and responses from others can then feed each other over time. This is not a diagnosis or a way to blame a family. Stress, discrimination, trauma and current danger also matter; experiences differ.
Four areas of skills
Mindfulness means noticing what is happening and returning attention with less judgement. Distress tolerance means getting through a difficult moment without adding harm, and accepting what cannot be changed right now, while seeking help when needed. Emotion regulation means understanding emotions, changing those you want to change, and building conditions that make them more manageable. Interpersonal effectiveness means working towards needs, relationships and self-respect, while protecting safety. These skills take practice and adaptation; becoming calm is not a test of success.
Understanding is not approving
Validation means recognising what makes sense about an experience in its context. You can acknowledge fear, hurt or an understandable wish without agreeing with an unverified belief or approving harmful behaviour. For example, someone feels hurt when a visit is cancelled and shouts. Their hurt makes sense, and they can still work on a response that does not involve shouting. You can offer the same understanding to your own experiences. Safety and responsibility remain important.
What kind of support are you being offered?
Comprehensive treatment combines individual therapy, skills training, agreed between-session support and a therapist consultation team. A skills group or individual work using selected skills is a different offer. These resources do not provide a complete programme, crisis monitoring or guaranteed replies. Ask your therapist what your service provides, how practice will be reviewed and whom to contact between sessions. Reviewing an action or missed practice is collaborative learning, never a sanction.
Choice and safety
You can stop at any point. If distress rises, pause and contact your therapist through your agreed route.
This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
Your reflection
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When to use ‘Understanding DBT: acceptance, change and skills’
‘Understanding DBT: acceptance, change and skills’ is a psychoeducation handout based on dialectical behaviour therapy (DBT). Consider this resource when exploring how a client responds to intense emotions, distress or relationship difficulties, and where acceptance or a change in response might fit.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 10 minutes. It moves through six short sections to read:
- Understanding and changing together: Dialectical behaviour therapy (DBT), developed by Marsha Linehan, brings together understanding your experience and learning ways to…
- Why emotions can become hard to manage: The biosocial model is one way to understand how biology and surroundings affect each other. Some people react strongly or quickly and take…
- Four areas of skills: Mindfulness means noticing what is happening and returning attention with less judgement. Distress tolerance means getting through a…
- Understanding is not approving: Validation means recognising what makes sense about an experience in its context. You can acknowledge fear, hurt or an understandable wish…
- What kind of support are you being offered? Comprehensive treatment combines individual therapy, skills training, agreed between-session support and a therapist consultation team. A…
- Choice and safety: You can stop at any point. If distress rises, pause and contact your therapist through your agreed route. This worksheet is for feelings…
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The DBT approach behind it
‘Understanding DBT: acceptance, change and skills’ draws on dialectical behaviour therapy (DBT). DBT brings acceptance and change together: recognising an experience as it is while considering a different response. Its skills include mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. These offer ways to notice what is happening, stay with difficult moments, understand emotions and communicate needs. The therapist and client can consider which skills fit the situation.
It is intended as one part of a wider course of therapy rather than as advice or a diagnosis. The therapist can help decide how it fits the work and discuss what emerges.
Evidence & sources
This handout draws on dialectical behaviour therapy. Key sources include:
- Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
- Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford Press.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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